THERAPEUTIC NUTRITION
THERAPEUTIC NUTRITION
Useful information about the needs of cats and dogs with nutritionally sensitive health conditions.
Pancreatic Disorders
Exocrine Pancreatic Insufficiency in Dogs
Exocrine pancreatic insufficiency (EPI) is a syndrome in dogs caused by inadequate production of digestive enzymes, bicarbonate, and other substances needed for normal digestion of food. When digestive enzymes are insufficient or lacking, the result is maldigestion and malnutrition.
Common clinical signs of EPI in dogs include weight loss, despite a normal or increased appetite; small bowel diarrhea; steatorrhea; increased fecal volume and, in some cases, defecation frequency; and increased flatulence. Poor body condition, borborygmus, coprophagia and/or pica, and nervousness or aggressiveness also have been reported.1,2
The goals of nutritional intervention in dogs with exocrine pancreatic insufficiency are to provide enough energy and highly digestible nutrients to support ideal body condition, avoid nutrient deficiencies, and minimize clinical signs.
THERAPEUTIC NUTRITION
The exocrine pancreas has a large reserve capacity for digestive enzyme secretion. Signs of gastrointestinal problems associated with EPI (e.g., steatorrhea, chronic diarrhea) do not occur until most pancreatic enzyme secretions are lost.3,4
Key Messages
- Adding exogenous pancreatic enzymes to food at every meal is the main therapy for long-term management of dogs with EPI.
- Digestion capacity, particularly for fat digestion, does not fully return to normal despite adequate enzyme supplementation.5
- Dietary modification, such as lower fat or higher digestibility, may help reduce the severity of some clinical signs.6 However, diet choice depends on the individual dog since responses to different dietary strategies vary.6─9 In an individual patient, it may be necessary to try several diets before the most appropriate one is identified.
- An individual dog’s response to diet change may not correlate with dietary fat concentration.8
- A highly digestible, low-fiber commercial therapeutic gastrointestinal diet may be appropriate, particularly during initial treatment, until a dog’s nutritional status has improved and mucosal damage, if present, has been repaired.2,10,11
- Some dogs can be well managed long term on a commercial well-pet food when supplemented with pancreatic enzymes.12,13
- Cobalamin (vitamin B12) deficiency has been found in 75% to 82% of dogs diagnosed with EPI.7,10 If not corrected, hypocobalaminemia may result in treatment failure or complications.1 Vitamin B12 should be supplemented parenterally if testing reveals a deficiency. Oral supplementation may be adequate following stabilization.
THERAPEUTIC NUTRITION
“Your dog [dog’s name] has a condition in which [his/her] pancreas is not making enough enzymes to properly digest food. When food is not digested into its various components—like amino acids or fatty acids—those nutrients cannot be properly absorbed. A pancreatic enzyme supplement will need to be added to your dog’s food at every meal. I also recommend that we start [dog’s name] on a special diet that is highly digestible, low in fiber, and moderate in fat to see if it will help reduce some of your dog’s clinical signs.”
Related Tools and Content:
The Purina Body Condition System
The Purina Body Condition System is an easy and practical tool for assessing a pet's body composition.
Taking a Good Diet History
The only way to know what each patient really eats is to ask ꟷ and document the information in the medical record.
Purina Fecal Scoring Chart
The Purina Fecal Scoring Chart is a practical, easy-to-use tool that can help clients describe their pets’ stools.
Nutritional Assessment Is an Iterative Process: Screening Evaluation
Assessing a patient’s nutritional status is a recurring process that entails more than taking a diet history.
Nutritional Assessment Is an Iterative Process: Extended Evaluation
An extended nutritional evaluation is important for pets at risk for nutrition-related problems.
To Share With Pet Owner:
Screening Diet History Form
This short, screening diet history form is a practical, easy-to-use document that can help clients provide important information about their pets’ diets.
Switching Pet Foods - Dogs
Gradually transitioning onto a new diet minimizes the risk of stomach upset.
References
- Steiner, J. M. (2016). Exocrine pancreatic insufficiency. In L. P. Tilley & F. W. K. Smith, Jr. (Eds.), Blackwell’s five-minute veterinary consult: Canine and feline. (6th ed., pp. 474─475) John Wiley & Sons, Inc.
- Westermarck, E., & Wiberg, M. (2003). Exocrine pancreatic insufficiency in dogs. Veterinary Clinics of North America: Small Animal Practice, 33(5), 1165─1179. doi: 10.1016/s0195-5616(03)00057-3
- DiMagno, E. P., Go, V. L. W., & Summerskill, W. H. J. (1973). Relations between pancreatic enzyme outputs and malabsorption in severe pancreatic insufficiency. New England Journal of Medicine, 288(16), 813─815. doi: 10.1056/NEJM197304192881603
- Williams, D. A. (2020). Exocrine pancreas. In E. J. Hall, D. A. Williams, & A. Kathrani (Eds.), BSAVA manual of canine and feline gastroenterology (3rd ed., pp. 231─243). BSAVA.
- Westermarck, E., & Wiberg, M. (2012). Exocrine pancreatic insufficiency in the dog: Historical background, diagnosis, and treatment. Topics in Companion Animal Medicine, 27(3), 96─103. doi: 10.1053/j.tcam.2012.05.002
- Westermarck, E., Wiberg, M., & Juntilla, J. (1990). Role of feeding in the treatment of dogs with pancreatic degenerative atrophy. Acta Veterinaria Scandinavica, 31(3), 325─331. doi: 10.1186/BF03547544
- Hall, E. J., Bond, P. M., McLean, C., Batt, R. M., & McLean, L. (1991). A survey of the diagnosis and treatment of canine exocrine pancreatic insufficiency. Journal of Small Animal Practice, 32(12), 613─619. doi: 10.1111/j.1748-5827.1991.tb00903.x
- Westermarck, E., Junttila, J. T., & Wiberg, M. E. (1995). Role of low dietary fat in the treatment of dogs with exocrine pancreatic insufficiency. American Journal of Veterinary Research, 56(5), 600─605.
- Westermarck, E., & Wiberg, M. E. (2006). Effects of diet on clinical signs of exocrine pancreatic insufficiency in dogs. Journal of the American Veterinary Medical Association, 228(2), 225─229. doi: 10.2460/javma.228.2.225
- Batchelor, D. J., Noble, P.-J. M., Taylor, R. H., Cripps, P. J., & German, A. J. (2007). Prognostic factors in canine exocrine pancreatic insufficiency: Prolonged survival is likely if clinical remission is achieved. Journal of Veterinary Internal Medicine, 21(1), 54─60. doi: 10.1111/j.193901676.2007.tb02928.x
- Chandler, M. (2017). Nutritional management of exocrine pancreatic disease. In S. J. Ettinger, E. C. Feldman & E. Côté (Eds.), Textbook of veterinary internal medicine: Diseases of the dog and the cat (8th ed., pp. 1900─41). Elsevier.
- Campbell, S. (2010). Exocrine pancreatic insufficiency—canine. In Nestlé Purina PetCare handbook of canine and feline clinical nutrition (pp. 56─57). Nestlé Purina PetCare Company.
- Xenoulis, P. G. (2020). Exocrine pancreatic insufficiency in dogs and cats. In D. Bruyette (Ed.), Clinical small animal internal medicine (pp. 583─590). John Wiley & Sons, Inc.